Provider Demographics
NPI:1578795928
Name:HUEGERICH, STACY R (MPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:HUEGERICH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3513
Mailing Address - Country:US
Mailing Address - Phone:608-250-1775
Mailing Address - Fax:608-250-1777
Practice Address - Street 1:305 S LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-250-1775
Practice Address - Fax:608-250-1777
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11170-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist